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Resistant hypertension and aldosterone: an update.
Donald Clark1, Mustafa I Ahmed, David A Calhoun
1Department of Medicine, Division of Cardiovascular Disease, Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, AL 35294, USA. dtclark@uab.edu
The Canadian Journal of Cardiology
|April 24, 2012
Summary
Resistant hypertension (RHTN) is linked to aldosterone excess, a condition found in up to 21% of RHTN patients. Treating this excess with mineralocorticoid antagonists can improve blood pressure and obstructive sleep apnea (OSA).
Area of Science:
- Cardiology
- Endocrinology
- Nephrology
Background:
- Resistant hypertension (RHTN) affects a growing population, exacerbated by obesity, diabetes, and chronic kidney disease.
- Aldosterone's role in RHTN is increasingly recognized, with primary aldosteronism (PA) prevalent in 14-21% of RHTN patients.
- Hyperaldosteronism is associated with obstructive sleep apnea (OSA), potentially worsening OSA severity through fluid retention.
Purpose of the Study:
- To highlight the significant contribution of aldosterone excess to resistant hypertension.
- To explore the therapeutic benefits of mineralocorticoid antagonists in RHTN management.
- To investigate the link between hyperaldosteronism, RHTN, and OSA.
Main Methods:
- Review of prospective studies on primary aldosteronism prevalence in RHTN patients.
- Analysis of antihypertensive effects of mineralocorticoid antagonists in RHTN.
- Examination of studies linking aldosterone, RHTN, and OSA, including spironolactone's effect on OSA.
Main Results:
- Primary aldosteronism (PA) is found in 14-21% of patients with RHTN.
- Mineralocorticoid antagonists demonstrate significant antihypertensive effects in RHTN patients.
- Preliminary data suggests spironolactone improves OSA severity, supporting the aldosterone-OSA link.
Conclusions:
- Aldosterone excess is a key factor contributing to resistant hypertension.
- Mineralocorticoid antagonists are effective in managing RHTN.
- Targeting aldosterone may improve both RHTN and associated OSA.
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